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Medicine and the Law Exam Notes INTRODUCTION AND ETHICS Table of Contents NHS TRUST A V M [2001].................................................................................................................... R (ON APPLICATION OF BURKE) V GMC [2005]..................................................

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Medicine and the Law Exam Notes Table of Contents

INTRODUCTION AND ETHICS ............................................................................................................4 NHS TRUST A V M [2001]....................................................................................................................5 R (ON APPLICATION OF BURKE) V GMC [2005]..........................................................................................5 EVANS V UK [2007].............................................................................................................................6 R (ON APPLICATION OF NICKLINSONV MINISTRY OF JUSTICE [2012]................................................................6 A (CHILDREN CONJOINED TWINS) [2000]................................................................................................6 AIREDALE NHS TRUST V BLAND [1993]..................................................................................................6 R (ON APPLICATION OF BURKE) V GENERAL MEDICAL COUNCIL [2005]...........................................................7 NHS V D [2003].................................................................................................................................7 R (ON APPLICATION OF OLIVER BURKE) V GMC [2005]...............................................................................7 R V CAMBRIDGE DISTRICT HEALTH AUTHORITY (EX PARTE B) [1995]..............................................................7 CONSENT TO MEDICAL TREATMENT .................................................................................................9 AIREDALE NHS TRUST V BLAND [1993]....................................................................................................9 MENTAL CAPACITY ACT 2005..................................................................................................................9 RE C (ADULT: REFUSAL OF TREATMENT) [1994].......................................................................................10 RE MB [1997]..................................................................................................................................10 MS B V AN NHS HOSPITAL [2002].......................................................................................................10 RE BURKE [2005]...............................................................................................................................11 RE MB [1997]..................................................................................................................................12 RE C (ADULT: REFUSAL OF TREATMENT) [1994].......................................................................................13 AIREDALE NHS TRUST V BLAND [1933]..................................................................................................13 MCFALL V SHRIMP [1971]...................................................................................................................14 CHATTERTON V GERSON [1981]............................................................................................................14 FREEMAN V HOME OFFICE [1984].........................................................................................................15 RE T (ADULT: REFUSAL OF MEDICAL TREATMENT) [1992]..........................................................................15 RE RICHARDSON [1998]......................................................................................................................16 R V TABUSSUM [2000].......................................................................................................................16 MARSHALL V CURRY [1933].................................................................................................................16 MURRAY V MCMURCHY [1949]............................................................................................................16 RE F (MENTAL PATIENT: STERILISATION) [1990]........................................................................................17 RE Y (ADULT PATIENT: BONE MARROW TRANSPLANT) [1996].....................................................................18 AIREDALE NHS TRUST V BLAND [1993]..................................................................................................18 RE A (CONJOINED TWINS) [2000].........................................................................................................18 GILLICK V WEST NORFOLK AND WISBECH.................................................................................................19 RE E [1994]......................................................................................................................................19

MEDICAL MISFEASANCE I ...............................................................................................................20 THE NHS REDRESS ACT 2006...............................................................................................................21 BARNETT V CHELSEA & KENSINGTON HOSPITAL [1969]..............................................................................21 CASSIDY V MINISTRY OF HEALTH [1951].................................................................................................22 KENT V GRIFFITHS [2000]....................................................................................................................22 WILSHER V ESSEX AREA HA [1986].......................................................................................................23 BOLAM V FRIERN HOSPITAL COMMITTEE [1957]......................................................................................24 HUCKS V COLE [1968].........................................................................................................................24 MARRIOTT V WEST MIDLANDS HEALTH A UTHORITY [1999]......................................................................25 ROE V MINISTER FOR HEALTH [1954].....................................................................................................25 THE SAATCHI BILL................................................................................................................................25 MEDICAL MISFEASANCE II ..............................................................................................................27 CANTERBURY V SPENCE [1972].............................................................................................................27 REIBL V HUGHES [1980]......................................................................................................................28 SIDAWAY V BETHLEM ROYAL HOSPITAL [1987].........................................................................................28 GOLD V HARINGEY [1987]...................................................................................................................29 CHESTER V AFSHAR [2004]..................................................................................................................30 MONTGOMERY V LANARKSHIRE HEALTH BOARD [2015].............................................................................31 BARNETT V KENSINGTON AND CHELSEA HOSPITAL......................................................................................33 WILSHER V ESSEX AREA HEALTH AUTHORITY [1988].................................................................................34 BAILEY V MOD [2008].......................................................................................................................34 WRIGHT V CAMBRIDGE MEDICAL [2011]................................................................................................34 FAIRCHILD V GLENHAVEN FUNERAL SERVICES [2002].................................................................................35 BARKER V CORUS [2006].....................................................................................................................35 COMPENSATION ACT 2006 S.3..............................................................................................................35 CHESTER V AFSHAR [2004]..................................................................................................................36 GREGG V SCOTT [2005].......................................................................................................................36 LAW AT THE START OF LIFE .............................................................................................................38 EVANS V UK [2006]...........................................................................................................................38 HFEA EX P BLOOD..............................................................................................................................38 ABORTION ACT 1967..........................................................................................................................39 SECTION 58 OAPA 1861.....................................................................................................................39 58 ADMINISTERING DRUGS OR USING INSTRUMENTS TO PROCURE ABORTION......................................................39 59 PROCURING DRUGS, &C. TO CAUSE ABORTION..........................................................................................39 INFANT LIFE (PRESERVATION) ACT 1929......................................................................................................39 R V BOURNE [1938]...........................................................................................................................40 ABORTION ACT 1967 S1......................................................................................................................40 R V SMITH [1974]..............................................................................................................................41 JEPSON V THE CHIEF CONSTABLE OF WEST MERCIA POLICE CONSTABULARY [2003].........................................41 R V SS FOR THE HOME DEPARTMENT, EX P MELLOR [2001].......................................................................43 DICKSON V UK [2007]........................................................................................................................43 HUMAN FERTILISATION AND EMBRYOLOGY ACT 1990................................................................................43 ORGAN TRANSPLANTATION ............................................................................................................45

CORNEAL GRAFTING ACT 1952.............................................................................................................45 HUMAN TISSUE ACT 1961...................................................................................................................45 R V BENTHAM [2005].........................................................................................................................46 DOBSON V TYNESIDE HA [1996]...........................................................................................................46 RE A (A MINOR) [1992]......................................................................................................................47 DOBSON V NORTH TYNESIDE HA [1997]................................................................................................48 R V KELLY [1998]...............................................................................................................................48 RE A (A MINOR) [1992]......................................................................................................................49 S4 HTA [2004]..................................................................................................................................50 SECTION 27(4) HTA [2004].................................................................................................................51 ARTICLE 19 OF THE EUROPEAN CONVENTION OF HUMAN RIGHTS AND BIOMEDICINE........................................51 HUMAN TISSUE ACT 2004...................................................................................................................52 SECTION 1.............................................................................................................................................. 52 HTA 2004 S32..................................................................................................................................52 RE Y (ADULT PATIENT: BONE MARROW TRANSPLANT) [1996].....................................................................53 STRUNK V STRUNK [1969]...................................................................................................................53 RE PESKINSKI [1975]..........................................................................................................................53 OPT-IN SYSTEM FOR TRANSPLANTATION..................................................................................................55

Introduction and Ethics Dual Regulation - Law and Medical Ethics Law = rules derived from statute or case law, enforced by the courts. Ethics – rules about what is good conduct. Medical ethics – precepts about the proper practice of medicine. [But traditionally focused on a single doctor/single patient model.] Professional Ethics – (traditionally) principles representing a consensus of learned (self-interested?) professional opinion about proper treatment of patients. (Now) Codes of professional conduct promulgated formally by professional associations, subject to professional self-regulation and enforcement [rather than external regulation by law] 

General Medical Council



Powers of GMC to discipline - Medical Act 1983

Good Medical Practice (2013) GMC http://www.gmc-uk.org/guidance/good_medical_practice.asp THE UNAVOIDABILITY OF PHILOSOPHY Normative philosophy is concerned with exploring ‘ought’ questions: how ought the NHS allocate its limited resources? Should patients be assisted to die? Involves asking deep philosophical questions about the nature of ethics, the value of life, what it is to be a person, the significance of being human, and how we should distribute valuable resources. Questions of policy and legal reform cannot be settled on pragmatic considerations alone. ENCROACHMENT OF LAW Warnock Committee on Human Fertilisation and Embryology (1984) Cmnd 9314 -------Human Fertilisation and Embryology Act 1990 Scandal at the Churchill clinic ---- Human Organ Transplants Act 1989 Access to Medical Treatments (Innovation) Act 2016 – encourages innovation.

Human Rights as a Source of Law Human Rights Act 1998

2. - (1) A court or tribunal determining a question which has arisen in connection with a Convention right must take into account any- (a) judgment, decision, declaration or advisory opinion of the European Court 3. - (1) So far as it is possible to do so, primary legislation and subordinate legislation must be read and given effect in a way which is compatible with the Convention rights. 4. (2) If the court is satisfied that the provision is incompatible with a Convention right, it may make a declaration of that incompatibility. 6. (1) It is unlawful for a public authority to act in a way which is incompatible with a Convention right. What is a Public Authority?

The European Convention on Human Rights

Article 2 - Right to Life Everyone's right to life shall be protected by law. No one shall be deprived of his life intentionally save in the execution of a sentence of a court following his conviction of a crime for which this penalty is provided by law. NHS Trust A v M [2001] Fam 348  

Duty on a state to protect and preserve life is not absolute Decision to withhold treatment not in the patient’s best interests would not breach Art 2.

Article 3 - Prohibition of Torture No one shall be subjected to torture or to inhuman or degrading treatment or punishment. R (on application of Burke) v GMC [2005] EWCA Civ 1003 Held: (i) Autonomy and the right to self-determination do not entitle the patient to insist on a particular medical treatment. (ii) If treatment were withdrawn the suffering would be the result of the medical condition and the doctors would not be guilty of torture or inhuman and degrading treatment.

Article 8 - Right to respect for private and family life Everyone has the right to respect for his private and family life, his home and his correspondence.. Evans v UK [2007] ECHR Grand Chamber (App no. 63395) Natalie Evans had stored frozen embryos prior to cancer treatment. Partner later withdrew consent to their use and requested destruction.   

Conflict between Art 8 interests of two people. No reason for favouring E’s Art 8 rights. UK rule – requiring consent of both parties was acceptable.

Article 14 - Prohibition of discrimination The enjoyment of the rights and freedoms set forth in this Convention shall be secured without discrimination on any ground such as sex, race, colour, language, religion, political or other opinion, national or social origin, association with a national minority, property, birth or other status. R (on application of Nicklinsonv Ministry of Justice [2012] EWHC 2381 The Incorporation of Ethics A (Children Conjoined twins) [2000] 4 All ER 961, [2001] 2 WLR 480 Re Quinlan (1976) 70 NJ 10. (required endorsement by ethics committee) Cp: Debates surrounding the Medical Innovation Bill Gillick v W Norfolk & Wisbech Area Health Authority [1986] AC 112 at 193-4: "… the occasions of a departmental non-statutory publication raising … a clearly defined issue of law, unclouded by political, social or moral overtones, will be rare. In cases where any proposition of law implicit in a departmental advisory document is interwoven with questions of social and ethical controversy, the court should, in my opinion, exercise its jurisdiction with the utmost restraint, confine itself to deciding whether the proposition of law is erroneous and avoid either expressing ex cathedra opinions in areas of social and ethical controversy in which it has no claim to speak with authority or proffering answers to hypothetical questions of law which do not strictly arise for decision." Per Lord Bridge

Practicalities and Resources - when should legal process be invoked? Airedale NHS Trust v Bland [1993] 1 ALL ER 821 "It would not be lawful for a medical practitioner who assumed responsibility for the care of an unconscious patient simply to discontinue treatment in circumstances

where continuation of it would confer some benefit on the patient" Goff

Per Lord

R (on application of Burke) v General Medical Council [2005] EWCA Civ 1003 Para 69. “The Intensive Care Society informed us that each year approximately 50,000 patients are admitted to intensive care units and of these 30% die in the unit or on the wards before hospital discharge. Most of these die because treatment is withdrawn or limited, albeit in circumstances where the clinicians conclude that such treatment would be likely merely to prolong the process of dying. There is not always agreement on the part of all concerned as to the withdrawal of treatment. This is hardly surprising. Grief stricken relatives may not be able to accept that the patient is beyond saving. The ICS calculates that, if Munby J's criteria were applied, approximately 10 applications a day would have to be made to the courts. Para 70. In the event, we do not consider that the judge is right to postulate that there is a legal duty to obtain court approval to the withdrawal of ANH in the circumstances that he identifies. Per Lord Phillips MR

NHS v D [2003] EWHC 2793 (Fam) terminations of pregnancies in mentally incapacitated women are not uncommon. And I agree that it would be both impractical and unnecessary to require that in each case an application to the court be made for a declaration of lawfulness. In my view, where the issues of capacity and best interests are clear and beyond doubt, an application to the court is not necessary. Per Coleridge J. R (on application of Oliver Burke) v GMC [2005] EW...