the intersection of ethics, law and health dr austen garwood-gowers nottingham trent university,...
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The Intersection of Ethics, Law and HealthThe Intersection of Ethics, Law and Health
Dr Austen Garwood-GowersDr Austen Garwood-GowersNottingham Trent University, United Nottingham Trent University, United
KingdomKingdom
Ethics Seminary, Guayaquil, March 2011 Ethics Seminary, Guayaquil, March 2011
Historical AspectsHistorical Aspects
• Intersection of health and ethics long understood Intersection of health and ethics long understood especially with regard to justifying intervention, especially with regard to justifying intervention, patient data and quality of care.patient data and quality of care.
• Protection of these areas reflected in application of:Protection of these areas reflected in application of:-- general criminal, civil and public law general criminal, civil and public law protections of protections of bodily integrity. bodily integrity.
• -- criminal and civil protection of confidentiality criminal and civil protection of confidentiality and and public law right to private life.public law right to private life.-- civil and even criminal protections against civil and even criminal protections against negligent negligent behaviour.behaviour.
• Also early development of specific health Also early development of specific health legislation on abortion, public health, mental legislation on abortion, public health, mental health, anatomical examination of cadavers etc.health, anatomical examination of cadavers etc.
Toward Modern TimesToward Modern Times• Growth in legislation in new areas, for exampleGrowth in legislation in new areas, for example
-- assisted reproductionassisted reproduction-- capacity and treatment of the incapable capacity and treatment of the incapable -- new forms of medical use of human body like new forms of medical use of human body like bio-bio- banking and transplantationbanking and transplantation
• Value of codification recognisedValue of codification recognised• Also a response to developments, particularly in Also a response to developments, particularly in
biotechnology.biotechnology.
• ‘‘Hard law’ protections supplemented by more Hard law’ protections supplemented by more standard setting documents produced by medical standard setting documents produced by medical institutions, governments and professional institutions, governments and professional groupings. groupings.
From National to From National to InternationalInternational
• 2020thth Century hard and soft law increasingly Century hard and soft law increasingly expands to regional and global levels.expands to regional and global levels.
• Better protection of human beings in the Better protection of human beings in the wake of the terrible atrocities of World War wake of the terrible atrocities of World War II.II.
• General human rights frameworks emerged. General human rights frameworks emerged.
• Also impulse to generate frameworks Also impulse to generate frameworks specific to the protection of rights in health specific to the protection of rights in health
• New wave of these in the late 20New wave of these in the late 20thth century. century.
Global General Human Global General Human RightsRights
• United Nations Charter 1945United Nations Charter 1945
• Universal Declaration of Human Universal Declaration of Human RightsRights 1948 (1948 (UDHR) UDHR)
• The International Covenant on Civil The International Covenant on Civil and Political Rights 1966and Political Rights 1966 (ICCPR) (ICCPR)
• UN UN Convention on the Rights of Convention on the Rights of Persons with Disabilities 2006 (CRPDPersons with Disabilities 2006 (CRPD))
Regional – European Regional – European Convention on Human Rights Convention on Human Rights (1950) (1950) • Also generated in wake of World War II horrors. Also generated in wake of World War II horrors.
• Range of rights relevant to protecting human Range of rights relevant to protecting human beings in the medical context. beings in the medical context.
• European Commission on Human Rights started European Commission on Human Rights started in 1954, European Court of Human Rights started in 1954, European Court of Human Rights started in 1959, taking sole charge of generating in 1959, taking sole charge of generating jurisprudence in 1998.jurisprudence in 1998.
• Convention jurisprudence exists on a wide range Convention jurisprudence exists on a wide range of medical issues making it a useful model.of medical issues making it a useful model.
Protection of Embryo and Protection of Embryo and Rights of Pregnant WomanRights of Pregnant Woman
• Demand for protection of the foetus under Demand for protection of the foetus under Art 2 right to life has failed: Paton v UK Art 2 right to life has failed: Paton v UK (1981) 3 EHRR 408; Vo v France (2005) 10 (1981) 3 EHRR 408; Vo v France (2005) 10 EHRR 12. EHRR 12.
• Member states powerful ‘margin of Member states powerful ‘margin of appreciation’ to determine their national appreciation’ to determine their national position. position.
• Means challenges to restrictions on Means challenges to restrictions on abortion usually fail: Bruggeman and abortion usually fail: Bruggeman and Scheuten v Germany App No. 6959/75, Scheuten v Germany App No. 6959/75, claimants A and B in ABC v Ireland (2010) claimants A and B in ABC v Ireland (2010) No. 25579/05. No. 25579/05.
Protection of Embryo and Protection of Embryo and Rights of Pregnant WomanRights of Pregnant Woman
The only successful challenges have been where the The only successful challenges have been where the CourtCourt
can criticise the member state as internally inconsistent: can criticise the member state as internally inconsistent:
• Tysiac v Poland (2007) 1 FCR 666 state lacked a Tysiac v Poland (2007) 1 FCR 666 state lacked a mechanism for women to challenge decisions that mechanism for women to challenge decisions that they didn’t meet legal criteria for abortion (Art 8 they didn’t meet legal criteria for abortion (Art 8 private life); private life);
• C in ABC v Ireland – law allowed abortion where C in ABC v Ireland – law allowed abortion where woman’s life at threat but difficult to obtain in woman’s life at threat but difficult to obtain in practice (Art 8 private life); practice (Art 8 private life);
• Open Door Counselling & Dublin Well Woman Clinic v Open Door Counselling & Dublin Well Woman Clinic v Ireland (1992) 15 EHRR 244 – abortion was legal to Ireland (1992) 15 EHRR 244 – abortion was legal to protect life so totally prohibiting provision of protect life so totally prohibiting provision of information & counselling about it was excessive (Art information & counselling about it was excessive (Art 10 freedom of expression). 10 freedom of expression).
Assisted SuicideAssisted Suicide
• No right to assist suicide (R v UK (1983) 33 DR No right to assist suicide (R v UK (1983) 33 DR 270) or to be assisted (Pretty v UK (1983) DR 33, 270) or to be assisted (Pretty v UK (1983) DR 33, Haas v Switzerland No 31322/07) Haas v Switzerland No 31322/07)
• Desire to be assisted is part of the autonomy Desire to be assisted is part of the autonomy protected by Article 8 but states can argue that protected by Article 8 but states can argue that the interference is justifiable where it is laid the interference is justifiable where it is laid down clearly in lawdown clearly in law
• But Court has focused on dangers to others if But Court has focused on dangers to others if assisted suicide is allowed not on the argument assisted suicide is allowed not on the argument that it is intrinsically wrong (contrast Canadian that it is intrinsically wrong (contrast Canadian case of Rodriguez v British Columbia [1993] 3 case of Rodriguez v British Columbia [1993] 3 S.C.R. 513).S.C.R. 513).
• This has already come back to haunt the UK …This has already come back to haunt the UK …
Examples of other areasExamples of other areas
• Detention in cases of mental health – range of Detention in cases of mental health – range of cases under Article 5 cases under Article 5
• Forced treatment of incapable adults and minors Forced treatment of incapable adults and minors raises Art 8 private life and Art 3 inhuman and raises Art 8 private life and Art 3 inhuman and degrading treatment issues, see e.g. X v degrading treatment issues, see e.g. X v Denmark (1983) 32 DR 282, Herczegfalvy v Denmark (1983) 32 DR 282, Herczegfalvy v Austria (1992) 15 EHRR 437Austria (1992) 15 EHRR 437
• Treatment of child without regard to parental Treatment of child without regard to parental rights – Glass v UK (No. 61827/00, §§ 74-83, rights – Glass v UK (No. 61827/00, §§ 74-83, ECHR 2004-II); ECHR 2004-II);
• Routine police retention of samples from those Routine police retention of samples from those who have been charged but not prosecuted or who have been charged but not prosecuted or though prosecuted not convicted – violation of though prosecuted not convicted – violation of Art 8 (Marper v UK (2008) ECHR 1581)Art 8 (Marper v UK (2008) ECHR 1581)
Examples of other regional Examples of other regional instruments backed by instruments backed by CourtsCourts
• Other regions of the world have dedicated Other regions of the world have dedicated human rights frameworks and are building up a human rights frameworks and are building up a body of jurisprudence that includes health cases.body of jurisprudence that includes health cases.
• Banjul Charter (African Charter on Human and Banjul Charter (African Charter on Human and People’s Rights 1981) – small body of case lawPeople’s Rights 1981) – small body of case law
• American Convention on Human Rights 1969 - American Convention on Human Rights 1969 - various provisions applying to health field. Case various provisions applying to health field. Case law example: Victor Rosario Congo v Ecuador, law example: Victor Rosario Congo v Ecuador, Inter American Commission of Human Rights Inter American Commission of Human Rights Case 11.427 Case No 63/99 (1999)Case 11.427 Case No 63/99 (1999)
Global human rights Global human rights instruments in the health fieldinstruments in the health field
Key instruments include:Key instruments include:
• UNESCO’s UNESCO’s Universal Declaration on the Universal Declaration on the Human Genome and Human Rights 1997 Human Genome and Human Rights 1997 (UDHGHR) and (UDHGHR) and
• Universal Declaration on Bioethics and Universal Declaration on Bioethics and Human Rights 2005 (UDBHR) Human Rights 2005 (UDBHR)
• Council of Europe’sCouncil of Europe’s Convention on Human Convention on Human Rights and Biomedicine 1997 (CHRB) Rights and Biomedicine 1997 (CHRB)
Global human rights Global human rights instruments in the health fieldinstruments in the health field
Key instruments include:Key instruments include:
• UNESCO’s UNESCO’s Universal Declaration on the Universal Declaration on the Human Genome and Human Rights 1997 Human Genome and Human Rights 1997 (UDHGHR) and (UDHGHR) and
• Universal Declaration on Bioethics and Universal Declaration on Bioethics and Human Rights 2005 (UDBHR) Human Rights 2005 (UDBHR)
• Council of Europe’sCouncil of Europe’s Convention on Human Convention on Human Rights and Biomedicine 1997 (CHRB) Rights and Biomedicine 1997 (CHRB)
Convention on Human Rights Convention on Human Rights and Biomedicine as an and Biomedicine as an exemplarexemplar• Preamble - developments in medicine and biology Preamble - developments in medicine and biology
should be used solely for the benefit of current and should be used solely for the benefit of current and future generations, individual and human species future generations, individual and human species should be shielded from threat should be shielded from threat
• Article 1 : ‘Parties to this Convention shall protect the Article 1 : ‘Parties to this Convention shall protect the dignity and identity of all human beings and guarantee dignity and identity of all human beings and guarantee everyone, without discrimination, respect for their everyone, without discrimination, respect for their integrity and other rights and fundamental freedoms integrity and other rights and fundamental freedoms with regard to the application of biology and with regard to the application of biology and medicine.’medicine.’
• Article 2: ‘The interests and welfare of the human Article 2: ‘The interests and welfare of the human being shall prevail over the sole interest of society or being shall prevail over the sole interest of society or science’. science’.
Establishing Normative Establishing Normative InterrelationshipsInterrelationships
Autonomy(freedom from and freedom to)
Integrity(psychical and
physical inviolability)
EqualityIdentity
Non-artificialisation of lifeNon-commodification
DIGNITY
Applications of Convention’s Applications of Convention’s emphasis on human rights and emphasis on human rights and dignitydignityEquitable access to healthcare (Art 3)Equitable access to healthcare (Art 3)Professional standards (Art 4)Professional standards (Art 4)Consent and intervention without it (Art 5-9)Consent and intervention without it (Art 5-9)Private life and right to information (Art 10)Private life and right to information (Art 10)Controls on genetics and prohibition of Controls on genetics and prohibition of
discrimination discrimination (Art 11-13)(Art 11-13)Research (Art 15-18)Research (Art 15-18)Living donation of organs and tissues for transplant Living donation of organs and tissues for transplant (Arts 21-22)(Arts 21-22)Various additional protocols such as on cloning, Various additional protocols such as on cloning,
researchresearch
World Medical Community World Medical Community InstrumentsInstrumentsWorld Medical Association (WMA): World Medical Association (WMA): • Declaration of GenevaDeclaration of Geneva Physicians OathPhysicians Oath 19481948 • International Code of Medical Ethics 1949International Code of Medical Ethics 1949• Built on the doctors trial and Nuremburg Code through Built on the doctors trial and Nuremburg Code through
the Declaration of Helsinkithe Declaration of Helsinki
Council for International Organizations of Medical Council for International Organizations of Medical Sciences in collaboration with WHO:Sciences in collaboration with WHO:
International Ethical Guidelines For Biomedical International Ethical Guidelines For Biomedical Research Involving Human Subjects 2002 Research Involving Human Subjects 2002
Regional and Global Provision: Regional and Global Provision: Imposition or Necessity?Imposition or Necessity?
• Not imposed - commitments that states choose Not imposed - commitments that states choose to make to make
• Human rights and dignity belong to the people – Human rights and dignity belong to the people – government should cherish and protectgovernment should cherish and protect
• Regional and international frameworks exert Regional and international frameworks exert moral, political and legal pressure on states to moral, political and legal pressure on states to ensure that they protect.ensure that they protect.
Total scope of domestic, Total scope of domestic, regional and international regional and international provisionprovision
• Going beyond vision of governance of Going beyond vision of governance of the doctor-patient relationship the doctor-patient relationship envisaged in ancient codes such as envisaged in ancient codes such as the Hippocratic Oaththe Hippocratic Oath
• Not just about new bioethics/law Not just about new bioethics/law stemming from biotechnologystemming from biotechnology
• Also growing global emphasis on Also growing global emphasis on extending protection beyond so-called extending protection beyond so-called first generation civil rights…first generation civil rights…
Total scope of domestic, Total scope of domestic, regional and international regional and international provisionprovision• Health is ultimately about well-being – Health is ultimately about well-being –
everything!everything!• Ecuador constitution rights: water (Art 12); Ecuador constitution rights: water (Art 12);
nutritious food (Art 13); good environment (Art nutritious food (Art 13); good environment (Art 14); protection of vulnerable classes (Art 35); 14); protection of vulnerable classes (Art 35); decent life & personal wellbeing (Art 66). decent life & personal wellbeing (Art 66).
• Banjul Charter (African Charter on Human and Banjul Charter (African Charter on Human and People’s Rights 1981): People’s Rights 1981): -- Union Interafricaine des Droits de l’Homme Union Interafricaine des Droits de l’Homme v v ZaireZaire (Communication 100/93); (Communication 100/93); -- The Social and Ecomonic Rights Action The Social and Ecomonic Rights Action Center Center and The Center for Economic and and The Center for Economic and Social Rights v Social Rights v NigeriaNigeria (155/96) (155/96)
Nonetheless, still some Nonetheless, still some issues…issues…• Pace of technological change outstripping ethico-legal Pace of technological change outstripping ethico-legal
discoursediscourse
• International and regional instruments have only brought International and regional instruments have only brought partial convergence at the national levelpartial convergence at the national level
• Convergence is only good if the approach that is being Convergence is only good if the approach that is being converged on is a good one converged on is a good one
• Unnecessary duplication – too many Unnecessary duplication – too many instruments/provisions to consider – potentially confusing instruments/provisions to consider – potentially confusing for practitioners for practitioners
• Alignment problems – both between instruments and Alignment problems – both between instruments and between different provisions within an instrumentbetween different provisions within an instrument
• Case study; respect but conflicting emphasis on medical Case study; respect but conflicting emphasis on medical use of the human body at the cost of respect use of the human body at the cost of respect
Medical use at the cost of Medical use at the cost of respectrespect
• In transplantation, medical research, bio-banking etc.In transplantation, medical research, bio-banking etc.
• Often targeted at specific classes . Often targeted at specific classes .
• Most domestic provisions allow use of the body after Most domestic provisions allow use of the body after death for transplant and other purposes without death for transplant and other purposes without requiring consent to this prior to death.requiring consent to this prior to death.
• Some instruments have provisions which appear to Some instruments have provisions which appear to dilute protection of the incapable in research, in dilute protection of the incapable in research, in conflict with their overarching emphasis on respect: conflict with their overarching emphasis on respect:
-- Principle 27 of the Declaration of Helsinki Principle 27 of the Declaration of Helsinki -- Art 17 of the CHRBArt 17 of the CHRB-- Mental Capacity Act 2005Mental Capacity Act 2005
Also a problem of practice and Also a problem of practice and enforcement of law enforcement of law
• Patterns of practice often seek out all Patterns of practice often seek out all vulnerable classes for use. vulnerable classes for use.
• Reinforced by inadequate rule Reinforced by inadequate rule enforcement, e.g. enforcement, e.g.
-- abuses in research abuses in research
-- abuses in the field of use of human abuses in the field of use of human tissue tissue and organsand organs
Also underpinned by theoretical Also underpinned by theoretical supportsupport
Addressing the shortfallsAddressing the shortfalls
• State and medical profession duty to State and medical profession duty to avert/provide redress for medical avert/provide redress for medical abuse.abuse.
• Duty usually legal as well as moral & Duty usually legal as well as moral & political.political.
• But history shows public can’t simply But history shows public can’t simply leave protection to authorities. leave protection to authorities.
• Public must monitor, encourage and Public must monitor, encourage and pressure for highest level of pressure for highest level of protection.protection.
References/further readingReferences/further reading• Dute, J. (2005), The Leading Principles of the Convention on Dute, J. (2005), The Leading Principles of the Convention on
Human Rights and Biomedicine, in Human Rights and Biomedicine, in Health Law, Human Rights and Health Law, Human Rights and the Biomedicine Conventionthe Biomedicine Convention, edited by M. Nijhoff, Leiden: Martinus , edited by M. Nijhoff, Leiden: Martinus Nijhoff Publishers, 3-12.Nijhoff Publishers, 3-12.
• Gadd, E. (2001), General Provisions of the Convention. Gadd, E. (2001), General Provisions of the Convention. Journal Journal International de BioethiqueInternational de Bioethique 12(1): 21-49. 12(1): 21-49.
• Garwood-Gowers, A. (2006), Vindicating the right to bodily Garwood-Gowers, A. (2006), Vindicating the right to bodily security of the incapable in research. security of the incapable in research. Journal of Mental Health Law,Journal of Mental Health Law, 7-25.7-25.
• Garwood-Gowers, A. (2008), The right to bodily security vis-à-vis Garwood-Gowers, A. (2008), The right to bodily security vis-à-vis the needs of others, in the needs of others, in Autonomy and Human Rights in Autonomy and Human Rights in Healthcare: An International Perspective, Healthcare: An International Perspective, edited by Weisstub, D edited by Weisstub, D and Diaz-Pintos, G. London: Springer, 375-397.and Diaz-Pintos, G. London: Springer, 375-397.
• Kayess, R. and French, P. (2008), Out of darkness into light? Kayess, R. and French, P. (2008), Out of darkness into light? Introducing the Convention on the Rights of Persons with Introducing the Convention on the Rights of Persons with Disabilities. Disabilities. Human Rights Law ReviewHuman Rights Law Review 1- 34. 1- 34.
• Palazzani, L. (2008), Person and Human Being in Bioethics and Palazzani, L. (2008), Person and Human Being in Bioethics and BioLaw, in BioLaw, in Autonomy and Human Rights in Healthcare: An Autonomy and Human Rights in Healthcare: An International Perspective, International Perspective, edited by Weisstub, D and Diaz-Pintos, edited by Weisstub, D and Diaz-Pintos, G. London: Springer, 89-98. G. London: Springer, 89-98.
• Zilgalvis, P. (2001), The European Convention on Human Rights Zilgalvis, P. (2001), The European Convention on Human Rights and Biomedicine: Its past, present and future, in and Biomedicine: Its past, present and future, in Healthcare Law: Healthcare Law: The Impact of the Human Rights Act The Impact of the Human Rights Act 1998, edited by A. Garwood-1998, edited by A. Garwood-Gowers, J. Tingle, T. Lewis, London: Cavendish.Gowers, J. Tingle, T. Lewis, London: Cavendish.
Workshop on Respecting the Human Being Workshop on Respecting the Human Being in Healthcarein Healthcare
Austen Garwood-GowersAusten Garwood-GowersNottingham Trent UniversityNottingham Trent University
Ethics Seminary, Guayaquil, March 2011 Ethics Seminary, Guayaquil, March 2011
IntroductionIntroduction• Respect for the human being is perhaps the key Respect for the human being is perhaps the key
issue in healthcare law and ethicsissue in healthcare law and ethics
• In this workshop the plan is to:In this workshop the plan is to:
-- Look at different case studies relating to it; Look at different case studies relating to it; -- Discuss relevant ethical principles raised;Discuss relevant ethical principles raised;-- Identify relevant elements of instruments; Identify relevant elements of instruments; -- Critically consider possible solutions; and Critically consider possible solutions; and -- Draw out wider lessons from the case Draw out wider lessons from the case studies.studies.
Consider in groups; what does Consider in groups; what does respect for human beings respect for human beings mean?mean?
1.1. How would you personally define what How would you personally define what a philosophy of respect for the human a philosophy of respect for the human being means?being means?
2.2. How does this relate to other How does this relate to other philosophies, including your own? philosophies, including your own?
3.3. What are the overarching provisions, if What are the overarching provisions, if any, that relate to respect in your any, that relate to respect in your instruments and how do they affect instruments and how do they affect your thinking, if at all?your thinking, if at all?
Examine these case studies Examine these case studies and apply your instruments to and apply your instruments to them.them.
1.1. What are the ethical principles at stake? What are the ethical principles at stake?
2.2. Relevant Articles?Relevant Articles?
3.3. How might these Articles apply?How might these Articles apply?
4.4. Is the potential outcome one you agree Is the potential outcome one you agree with?with?
Consent and capacity issuesConsent and capacity issues
1.1. Che, a man who is diagnosed as having a mental disorder, Che, a man who is diagnosed as having a mental disorder, wants to argue that since he has capacity to make wants to argue that since he has capacity to make decisions he should not be forced to have treatment. decisions he should not be forced to have treatment.
2.2. Fidel, a minor who has capacity, complains that he has less Fidel, a minor who has capacity, complains that he has less control over his decisions than a capable adult.control over his decisions than a capable adult.
3.3. Pablo argues that when the Court examines the interests Pablo argues that when the Court examines the interests of minors it should not simply substitute its own view for of minors it should not simply substitute its own view for that of the parents but should give priority to the approach that of the parents but should give priority to the approach of parents unless this is wholly unreasonable.of parents unless this is wholly unreasonable.
4.4. A local hospital wants to force a blood transfusion on A local hospital wants to force a blood transfusion on Isabella, a Jehovah’s witness who has capacity, on the Isabella, a Jehovah’s witness who has capacity, on the basis that if she dies it will leave the state with the basis that if she dies it will leave the state with the financial burden of caring for her children.financial burden of caring for her children.
5.5. Advise project prevention who wish to give people who are Advise project prevention who wish to give people who are drug addicts $300 to accept sterilisation.drug addicts $300 to accept sterilisation.
6.6. Advise a group called Norm who argue that circumcision of Advise a group called Norm who argue that circumcision of male babies should not be allowed except where medically male babies should not be allowed except where medically justified.justified.
Beginning of life issuesBeginning of life issues
1.1. Joanna and Sylvia, a lesbian couple, want to use in-vitro Joanna and Sylvia, a lesbian couple, want to use in-vitro fertilisation to have a baby and to select a female embryo fertilisation to have a baby and to select a female embryo to implant.to implant.
2.2. Cesc, who is in prison for at least 5 more years, wants to Cesc, who is in prison for at least 5 more years, wants to send his sperm by post to his 35 year old girlfriend. send his sperm by post to his 35 year old girlfriend.
3.3. Elisabeth wants to use genetic diagnosis to identify which Elisabeth wants to use genetic diagnosis to identify which or her in-vitro embryos is free of an inherited genetic or her in-vitro embryos is free of an inherited genetic problem and is genetically matched with an existing child problem and is genetically matched with an existing child with that condition. She hopes to implant such a foetus with that condition. She hopes to implant such a foetus and at birth use stem cells from the blood of its placenta to and at birth use stem cells from the blood of its placenta to treat her existing child. treat her existing child.
4.4. Francesca has a serious eye condition, continuing with her Francesca has a serious eye condition, continuing with her pregnancy may leave her blind, she wants an abortion.pregnancy may leave her blind, she wants an abortion.
5.5. Ilona wants to use prenatal testing to help avoid having a Ilona wants to use prenatal testing to help avoid having a female child.female child.
6.6. The authorities wish to detain Katherine, a drug addict, The authorities wish to detain Katherine, a drug addict, during her pregnancy in order to prevent harm to the during her pregnancy in order to prevent harm to the foetus.foetus.
Ending of Life IssuesEnding of Life Issues
1.1. Carlos, a capable adult, wants to commit suicide without Carlos, a capable adult, wants to commit suicide without anybody stopping him.anybody stopping him.
2.2. Maria, a capable adult, wants to have assisted suicide. Her Maria, a capable adult, wants to have assisted suicide. Her husband is willing to provide the assistance. husband is willing to provide the assistance.
3.3. Hugo, a capable adult, does not want continued ventilation, Hugo, a capable adult, does not want continued ventilation, withdrawal of which is almost certain to lead to his death.withdrawal of which is almost certain to lead to his death.
4.4. Sandro has a wasting condition and is worried that the health Sandro has a wasting condition and is worried that the health service will leave him to die painfully via loss of hydration and service will leave him to die painfully via loss of hydration and nutrition. He wishes to argue that he has a human right to not nutrition. He wishes to argue that he has a human right to not die a painful death when this can be avoided.die a painful death when this can be avoided.
5.5. Helena has an embryo which is encoded to twin but the Helena has an embryo which is encoded to twin but the division does not fully occur. Advise the local hospital who, division does not fully occur. Advise the local hospital who, after birth, want to split the single physical mass, which two after birth, want to split the single physical mass, which two beings are associated with. The intervention will cause the beings are associated with. The intervention will cause the ending of the life of one being but will almost certainly protect ending of the life of one being but will almost certainly protect the other.the other.
6.6. Jane has been diagnosed as being in a ‘vegetative state’ for Jane has been diagnosed as being in a ‘vegetative state’ for the last three years. The hospital want to stop providing the last three years. The hospital want to stop providing artificial ventilation, nutrition and hydration.artificial ventilation, nutrition and hydration.
Medical Use IssuesMedical Use Issues
1.1. Lula, an adult lacking capacity, complains he is subject to Lula, an adult lacking capacity, complains he is subject to research intervention inconsistent with his interests.research intervention inconsistent with his interests.
2.2. Manuel complains that the law does not protect his bodily Manuel complains that the law does not protect his bodily inviolability because it allows intervention on him after inviolability because it allows intervention on him after death without his specific informed consent.death without his specific informed consent.
3.3. An indigenous group seek assistance to identify why they An indigenous group seek assistance to identify why they have a high rate of diabetes. However, researchers plan to have a high rate of diabetes. However, researchers plan to secretly test their samples for other diseases and to secretly test their samples for other diseases and to identify their overall genetic makeup and heritage.identify their overall genetic makeup and heritage.
4.4. Zenda, wishes to force her cousin to donate bone marrowZenda, wishes to force her cousin to donate bone marrow
5.5. Jenny agreed to participate in a bio-bank. The Government Jenny agreed to participate in a bio-bank. The Government now want to examine the bank’s DNA records to help now want to examine the bank’s DNA records to help detect crime.detect crime.
6.6. The government develop a system of ‘presumed consent’ The government develop a system of ‘presumed consent’ under which unless you specifically refuse they presume under which unless you specifically refuse they presume you agree to your national health service data being used you agree to your national health service data being used in a national bio-bank run for profit in your country by a in a national bio-bank run for profit in your country by a private company. private company.