Tort - Therapeutic Privilege PDF

Preview

Summary

Following the Supreme Court’s decision in the case of Montgomery to inform patients of ‘material risks’, to what extent is there a true defence of therapeutic privilege for medical practitioners?

In looking at the development of TP following Montgomery, and with aid of international com...

Description

“ Thed o c t o ri st h e r e f o r eu n d e radu t yt ot a k er e a s on a bl ec a r et oe ns u r et h a tt h ep a t i e nti sa wa r eo fa n yma t e r i a l r i s ksi n v o l v e di na n yr e c o mme n d e dt r e a t me n t ,a n do fa n yr e a s o n a b l ea l t e r n a t i v eo rv a r i a ntt r e a t me n t s …Th e do c t o ri sh o we v e re n t i t l e dt owi t h h ol df r om t h ep a t i e n ti n f o r ma t i o na st oar i s ki fh er e a s on a b l yc on s i d e r st h a t i t sd i s c l o s u r ewo u l db es e r i o u s l yd e t r i me n t a lt ot hep a t i e n t ’ sh e a l t h . ”Mo n t g o me r yvLan a r k s h i r eHe a l t hBo a r d [ 2 01 5 ]UKSC1 1a t8 7a n d8 8 Fo l l o wi n gt heSu pr e meCo u r t ’ sd e c i s i oni nt h ec a s eofMo n t g ome r yt oi n f o r mp a t i e n t so f‘ ma t e r i a lr i s k s ’ ,t o wh a te x t e nti st h e r eat r u ed e f e n c eo ft h e r a p e u t i cpr i v i l e g ef o rme di c a lp r a c t i t i o n e r s ? Th ec a s eo fMo nt g o me r yvLa na r k s h i r eHe a l t hBo a r d1r e fin e d ,a n dn o t a b l yn a r r o we dt h el a w s u r r o un d i n gi n f o r me dc o n s e n t ,c l e a r l yi d e n t i f y i n gt h ed e f e n c eo fs u c ht ob et h a to ft h e r a p e u t i c p r i v i l e g e( TP) ,o t h e r wi s ekn o wna st h e r a p e u t i ce x c e p t i on( TE) .De s p i t et h ep a r a mo u ntc a s e p a r a l l e l i n gs o c i e t i e ss o c i a la n d mo r a la d v a n c e me n twi t hi t ss i g n i fic a n ts h i f tt op a t i e nt a ut o n o my ,i tc o u l db ea r gu a bl et h a t ,i nt h e o r y ,TPh i n de r st h en e c e s s a r ymo v ea wa yf r om me d i c a lp a t e r n a l i s m.I nl o o ki n ga tt h ede v e l op me n to fTPf o l l o wi n gMo n t g o me r y ,a n dwi t h a i do fi n t e r n a t i o na lc o mp a r i s o n,i ti se v i d e n tt ha ti mp l e me n t a t i o n oft h ee x c e p t i o ni s p r o b l e ma t i ca swe l la se x t r e me l yl i mi t e d.Wi t hd i ffic u l t yi ni n t e r p r e t a t i o no ft h es c o p e ,t oa l a c kofc o mp a t i b i l i t ywi t hp a t i e n ta u t o n omya n dap o s s i b l eo v e r l a pwi t ht h ed e f e n c eo f n e c e s s i t y ,i tb e g st h equ e s t i o na st owhe t h e rt h ede f e n c ema yon l yb ea b l et oe x i s ta sa c on c e p t .

1 .THEEVOLUTI ONOFTHERAPEUTI CPRI VI LEGE I n or d e rt oe ffe c t i v e l yu nd e r s t a n dt h es u bs e q u e n tp l a c eofTP a sa d e f e nc ef o l l o wi n g Mon t g o me r y ,i ti si n t e gr a lt ofir s te x p l o r et hel a wt h a tc a mep r i ora ndt h el a wa si ts t a n ds . I .

Pr e Mo n t g o me r y

2 Th ec a s eo fBo l a mvFr i e r nHo s p i t alMa n a g e me n tCo mmi t t e e p r o v i d e dt h el on gs t a n d i n gt e s t

wi t hr e g a r d st ome d i c a ln e g l i g e nc ewi t has t r o n gf o c u so np a t e r n a l i s m,i nwh i c hame d i c a l p r o f e s s i o n a l ’ sa c t i o nswe r ej u s t i fia b l es ol o n ga si twa sd e e me dr e a s o n a bl eb yabo d yof 1[ 2 0 1 5 ]UKSC1 1 2[ 1 9 5 7 ]1WLR5 8 2 1

3 me di c a lp r o f e s s i on a l so ft h es a mes p e c i a l i t y ,wi t hl i t t l ec o n s i d e r a t i o no fi n e x p e r i e n c e .Th i s 4 wa sd e v e l o p e dwi t h i nt h ec a s eo fSi d a wa yvBe t h l e m Ro y a lHo s pi t alGo v e r n o r s wh i c h

s t i p ul a t e daf o u n d a t i o no fu n de r s t a n d i n gt h a ts a i dt e s twa si n c l u s i v eofma t t e r sr e g a r d i n g i n f o r me dc on s e n t .I twa sc l a r i fie di nt h i st h a tTPwa sn o tas t a n d a l o n ed e f e n c e ,b u tr a t h e r i n c o r p o r a t e dwi t h i nt h eg e n e r a lp r i n c i p l e–t h ep r i n c i p l eo fb e ne fic e nc e . Th o u g ht h ep r e s i d i n gj u d g e me n ti nS i d a wa yk e p tc a r e f ul l ywi t h i nt h epa t e r na l i s tl i ne so f Bo l am,Lor dSc a r ma np r o v i d e dav a l u a b l edi s s e n t i n gj u d g e me n ti nwh i c hh ed i s p a r a g e dt h e i d e at h a tc o n s e n ts h o u l db ed e a l twi t hi nc on j u n c t i v ewi t ht het e s to fr e a s o n a b l e n e s ss e to u ti n Bo l am.Th ep r e d o mi na n tl i n eo fr e a s on i n gwa st h a tt hee l e me n to fc o n s e n ts u r p a s s e dt h a to f me r eme d i c a lkn o wl e d g e ,wi t ht h ec r u xofd oc t o r ’ sc o n c e r nr e l a t i n gt op a t i e nt ’ sp a i na n d 5 r e l i e f . I twa sma d ea p p a r e n tt h a tt h e r ema yb eamu l t i t u d eo fs u b j e c t i v ef a c t o r sn o td i s c l os e d

t ot hed o c t o rt h a tma yl e a dt h e mt oad i ffe r e n td e c i s i o nwi t hn or e l e v a n c et ome d i c a lo p i ni o n . Th es i g n i fic a n c eo ft h i sc a nb eb l a t a n t l ys e e nwi t h i ni n t e r n a t i o n a lj u r i s d i c t i o n sj ur i s p r u de n c e o fTP6a nd ,mo r er e l e v a n t l y ,t h ej u dg e me nto fMo n t g o me r y . I I .

Mo n t g ome r yv . La n a r ks h i r eHe a l t hBo a r d

Wi t hpi v o t a lc o n s i d e r a t i ont oLor dSc a r ma n ’ sv e ne r a b l ed i s s e n t i n gj u d g e me n t ,Mo n t g o me r y a dh e r e dt ot h es o c i a la n dl e ga lde v e l o p me nt st h a toffe r e daf a rmo r ea u t o n o mou sa p pr o a c ht o c on s e n t .Ana p p r o a c ht h a ta c k n o wl e d g e dt ha tt h ep a t i e ntwa sn ol o n g e rt ob et r e a t e da sme r e l y 7 8 a‘ p a s s i v er e c i p i e n to fc a r eo ft h eme d i c a lp r o f e s s i o n ’ ,b utr a t he r‘ p e r s on sh ol d i n gr i g h t s ’ 9 o v e r t u r n i ngt hej u d g e me nto fS i d a wa ya n dg i v i n gmuc hn e e d e dr e f o r mt ot h eBo l a mt e s t . Th e 1 0 j u d g e me n ta ffir me dt hec a s eo fPe a r c evUni t e dBr i s t o lHe a l t h c a r eNHST r u s t a n ds e p a r a t e d

3 Br a z i e r ,M. , & Mi o l a ,J , ‘ By e b y eBo l a m’ ,Me d i c a lLa w, Re v i e w, 8Sp r i n g 4[ 1 9 8 5 ]AC8 7 1 5 EmmaCa v e ,' Th eI l l I n f o r me d :Co n s e n tt oMe d i c a lTr e a t me n ta n dTh eTh e r a p e u t i cEx c e p t i o n' ] 6 Roge r sv . Wh i t a k e r( 1 99 2 )1 7 5CLR4 7 9f r a me wo r ko ft h eAu s t r a l i a nTP 7 n1a t[ 7 5 ] 8i b i d 9 Clark Hobson, ‘No, More Bolam Please’ 10 [ 1 9 9 9 ]PI QR5 3 ,5 9 2

1 1 t h er u l e ss u r r o un d i n gc o n s e ntt on ol o n g e rf a l lu n de rt h es a meb l a n k e tt e s to fr e a s o n a b l e n e s s

i n s t e a dma ki n gs ot ha ta l lme d i c a lpr o f e s s i o n a l sa r e‘ u n d e rad ut yt ot a k er e a s o n a b l ec a r et o e ns u r et h a tt h ep a t i e n ti sa wa r eo fa n y ma t e r i a lr i s ksi n v ol v e di na n yr e c o mme nde d 12 t r e a t me n t . ’

Al on g s i d ep r o v i di n gf o ran e wa p pr o a c ht oc o n s e n ta n di nf o r me dc o ns e n t ,t woe x c e p t i o nst o t h i sa ut o n o mo u sr u l ewe r es p e c i fie d ,fir s t l yb e i n gt hed e f e n c eo fn e c e s s i t yi nwh i c hme di c a l p r a c t i t i o n e r sa r ea b l et oo v e r r i dec o n s e nti ni n s t a n c e so fe me r g e n c yorwhe r et h ep a t i e n tl a c ks 13 c a p a c i t yt od os o . Se c o n d l y ,t h eTEi nwh i c ht h eDo c t o ro rme d i c a lp r o f e s s i o n a li se n t i t l e dt o

wi t h h o l dr i s ki fh er e a s o n a b l yc o n s i d e r sd i s c l o s u r ewo u l db es e r i ou s l yd e t r i me n t a lt ot h e p a t i e n t s ’h e a l t h .Th ea d di t i o noft h i ss e c o n dd e f e nc ep r o v i de df o ra ne x t r e me l yn a r r o we d v e r s i o no fwh a twa sp r e v i o u s l ys e e na sTP ,ma ki n gt h ej u mpf r o mb e i n gme r e l ya ma l g a ma t e d 1 4 wi t h i nt heg e n e r a lp r i n c i p l e ,t oas t a n da l o n ede f e nc e .

2 .AMBI GUI TY Ap r o mi n e n ti s s u ei na p p l y i n gt h eTEi sas i g n i fic a ntl a c ko fc l a r i t y ,ma ki n gf o ra ne xt r e me l y a mb i g u o u sa n dv ul n e r a b l ed e f e n c e .De s p i t eb e i n gc l e a r l yi d e n t i fie d ,t h es c op ewa sn o t ,wi t h 15 b o t ha f o r e me nt i o n e dj u d g e sd e e mi n gi t‘ u n n e c e s s a r yf o rt h epu r p o s e so f[ t h e ]c a s e ’ . Th i s

c r e a t e sab u r d e no fi n t e r p r e t a t i o n ,wi t ht hewo r dc ho i c eo f“ s e r i o u s l yd e t r i me n t a l ”a n d“ wo u l d h a v e ”b e i n go fp r o mi n e n tc o n c e r n . I .

“ Se r i o us l yDe t r i me n t a l ”

Wi t hn ol i g h ts h e do nwh a tma yb er e g a r d e da s“ s e r i o u s l yd e t r i me nt a l ” ,ad i s c r e t i o ni sl e f ti n d e t e r mi n i n ga st owh a two u l dq u a l i f ya ss u c h.I ti mp r e s s e sa nu n f a i re n c umb r a n c eo nt h e

11 n3 12 n1a t[ 8 7 ] 13 I b i da t[ 8 8 ] 14 Emi l yJ a c k s o n , Me d i c a lLaw:T e x t , Ca s e sa n dMa t e r i a l s( 4 t h e d n)2 1 2 15 n13 3

a bi l i t yf orme di c a lp r o f e s s i o n a l st or e l yo nt h ed e f e nc ea si tc a u s e sf o rab r o a dd i s c r e t i ont ob e 1 6 i n s t i l l e di no b j e c t i v e l yc o n s t r u i n gwha tma yb ec ons i d e r e d“ s e r i o us l yd e t r i me nt a l ” .

Th i sa r g u a bl yc a u s e sf o ra na l r e a d yl i mi t e dd e f e n c et ob e c o mee v e nmo r es o ,wi t hon l yo n e 1 7 c a s ewi t h i nEn g l a n da n dWa l e ss u c c e s s f ul l yu s i n gt h ed e f e n c e . Th ec a s eo fPe a r c e ,wh i c h

p r e d a t e sMo n t g ome r y ,i l l u s t r a t e samo r el e ni e n tp r i v i l e g ei nwh i c hTPwa sa c c e p t e do nt h e b a s i st h a tt h ed o c t o ro mi t t e dt oi nf o r m ap a t i e nto ft h e1 %r i s ko fs t i l lb i r t hd u et ot h ewo ma n 1 8 a pp e a r i n gdi s t r e s s e d . No to n l ywo ul dt hi sb ee x t r e me l yu nl i k e l yt oe q u a t et os e r i o u s l y

d e t r i me n t a l ,wi t hLa d yHa l ec o n s o l i da t i n gt ha tpr e gna n two me na r en ol o ng e rt ob es e e na s 19 l a c ki n gc a pa c i t yb u ti ns t e a da sa u t o n o mou sb e i n g s , i tl a r g e l yc o nc e r n st h ed e b a t eo nwh a ti s

as i g n i fic a ntr i s kwh i c hi n s t e a dwo u l df a l lu n d e rt heMo n t g o me r yp r i nc i p l e . I I .

“ Wo u l dh a v e ”

Fu r t h e r mo r e ,t h e r ei saq u e s t i o no fj us th o wl i t e r a l l yt hewo r dc h o i c eo f“ wo u l dh a v e ”s h o u l d b et a k e n.I tc o u l db ea r g u e dt h a tt h ep h r a s ep o s t u l a t e st ha tt heme di c a lp r o f e s s i o n a lmu s tb e u n de rt hei mp r e s s i o nt h a td i s c l o s u r ewi l lmo s td e fin i t e l yr e s ul ti nt h ep a t i e n tb e i n ga d v e r s e l y a ffe c t e dt ot h ep o i n to f‘ s e r i o u sde t r i me n t ’ ,a si fi twa sme r e l ys u p p o s i t i o n ,t h e nt h e ymi g h t h a v eo p t e df o rwo r dc h o i c et h a tr e fle c t e ds o ,e . g .“ ma y ” .Up o nt a k i n gt hi su nd e r s t a n d i ng ,i t wo u l db ef a i rt oa s s u meme di c a le v i de n c e wo ul db ee x pe c t e di n or d e rt ob a c kt h e i r c on c l u s i o n .Th o u g ht h i swo u l db ea ne x t r e me l yn a r r o wi nt e r p r e t a t i onoft h ede f e n c e ,t h e r ei s n owa yo fe l u c i da t i n gwh a te x a c t l yi sme a n t . Wi t ht h eu t i l i s a t i ono fb o t ho ft h e s ed i s t i n c tp h r a s e s ,i tma k e sf o rt h ed e f e nc et ob ed i ffic u l tt o p u ti nt opr a c t i c e ,s e t t i n gah a r dt oob t a i nb a l a n c eo fs u b j e c t i v i t ya n do b j e c t i v e n e s swh e n a s s e s s i n gd i s c l o s u r eo fma t e r i a lr i s k s .Ho we v e r ,al a c ko fc l a r i t yd oe sn o tma k ef o rt hed e f e n c e t ob er e n d e r e du n t r u e ,r a t h e rj u s ta c t sa sad i ffic u l th ur d l ei na p p l i c a t i o n.

3 .I STHEDEFENCEEFFECTI VEL YREDUDANT?

16 n5 17 Rac h a e lMu l h e r o n , ‘ Ha sMo n t g o me r yAd mi n i s t e r e dt h eLa s tRi t e st oTh e r a p e u t i cPr i v i l e g e ? ’ 18 n10 19 n1a t[ 1 1 6 ] 4

Aswe l la sad i ffic u l t yi ni n t e r pr e t i n go ft h es c o p eo ft h eTEi nEn gl a n da ndWa l e s ,t h e r ea r ea my r i a dofo t h e rf a c t o r swhi c hs c r u t i n i s et hea b i l i t yt oc l a s sTPa sa‘ t r u ede f e n c e ’ .Ani na b i l i t y t or e c o nc i l ewi t hp a t i e n ta u t o n o mya n do v e r l a pb o t ht h eMe n t a lCa p a c i t yAc t20 0 5( MCA) , a ndt h eo t he rd e f e n c eofn e c e s s i t ya l li mp e d et h el u c i di t yo ft h ed e f e n c e .

I .

Pa t i e n tAu t o n omy

Th ei mp or t a n c eo fp a t i e nta ut o n o my i spr e s s e d wi t h i na l mo s tt h ee n t i r ej u d g e me nto f Mon t g o me r y ,i ne s s e n c ei ti swh a ti ti sb a s e du p o na n di ti sb e c a u s eo ft h i st h a ti tma k e st he a dd i t i o noft h eTEt h a tmo r ep e r p l e x i n g . 2 0 I ti se xt r e me l yd i ffic u l tt os e ewh e r eTPc a ne x i s ti nc o ng r u e nc ewi t hpa t i e nta u t o n o , my

h o we v e r ,i th a sb e e na r g u e dt h a tt h e r ei st wowa y si nwh i c hi ti sp o s s i b l e : 1 )Wh e r ea n ob j e c t i o nt e s ti si n c o r p or a t e di n t ol a w whi c hp r e c l u d e s me d i c a l p r of e s s i on a l sf r om d i s c l os i n gr i s k st oc e r t a i np a t i e n t s 2 )Wh e r et h e r ei sn oo ffe rofp r o t e c t i o nt ov u l ne r a b l ep e o p l e ,t h o s ewh ol a c kc a p a c i t y ,o f 21 wh om ma ybeu n a bl et oma k ea ut o n o mo usde c i s i onwi t hr e g a r d st ot r e a t me n t

Th o u g ht h efir s ti n s t a n c ema yb ea p p l i c a bl ei nj ur i s d i c t i o n ss u c ha sNe w Yo r ki nwh i c ha n 2 2 o b j e c t i v et e s ti se n c o d e di n t ot he i rl e g i s l a t i o n ,i ti sn o ta p p l i c a b l ewi t h i nEn g l a n da ndWa l e s .

Si mi l a r l y ,t h es e c o n di sa ga i nn o tp e r t i ne n tt ot h el a w wi t h i nEn g l a n da n dWa l e sd u et ot he e x i s t e n c eo ft h eMCA.Wi t ht h el a c ko fr e c o n c i l i a t i o nTPh a swi t hpa t i e n ta u t o n omy ,i tc a l l s i n t oq u e s t i o na st owh e t h e ri ti smo r a l l ya n de t h i c a l l yr i g h tf o rt hee x c e p t i o nt ober e g a r d e da s a‘ t r u ede f e n c e ’ .Ho we v e r ,t h i sa g a i ni su n l i k e l yt or e d uc ei ta si n v a l i d . I I .

Th eMe n t a lCa p a c i t yAc t2 0 0 5

Wh e nd e b a t i n gt h ev a l i di t yoft h ed e f e n c e ,i ti si mp o r t a n tt oa pp r o a c hwh oe x a c t l yTPwo u l d a pp l yt o .I nd oi n gt h i s ,i ti sd i ffic u l tt ot h i n ko fas c e n a r i ot ha two u l dn o tc o n c e r nap e r s ont h a t

lL,‘ I n f o r me dc o n s e n t :mo r a ln e c e s s i t yo ri l l u s i o n ? ’ 20 Doya 21 n5 22 i b i d

5

2 3 l a c k e dc a p a c i t y ,wi t h o u to b s t r u c t i n gp a t i e nta u t o n omy . I nt hej u dg e me ntp r o v i d e db yLor d

Ke r ra n dLo r dRe i di nMo nt g o me r y ,i twa ss t a t e dt h a ta n y on eo f‘ s o u n dmi n d ’i se n t i t l e dt o 2 4 c on s e n ta n db ef u l l yi n f o r me do fs u c hc o n s e n t . Th i sl i n eo fa r g ume n ti sb a c k e dl a t e rwi t h i n

t h ej u d g e me ntb yLa d yHa l ei nwh i c hs h ea ffir mst h a t‘ s o u n dmi n d ’i ss y n o n y mo uswi t h c a p a c i t y ,i n s i n u a t i n gt h a tt heo n l yp e o p l ewh oa r en ote n t i t l e dt ob e i n gi n f o r me do fa n y ma t e r i a lr i s k si sl i mi t e dt ot h o s ewh od on o tl a c kc a p a c i t y . Po s s i b l eo v e r l a pb e t we e nt h eMCAa n dTPc a nb es e e nf r omt h eAus t r a l i a nc a s eo fBa t t e r s b y vT o t t ma n25i nwh i c hTPs u c c e e d e da sad e f e nc e .Th ec a s ec o n c e r n e dama nwh os u ffe r e d f r o mp s y c h os i swh owa sn o ti n f o r me do ft her i s kso fb e i n ga d mi n i s t e r e dt h ed r u go fMe l l e r i l . I ti sa r gu a b l et ha ti ft h i ss a mes c e n a r i owa st oo c c uri nEn g l a n da n dWa l e s ,t h eMCAwou l d b ei n v o k e dr a t h e rt h a nt h eTE.TheAc ts t i p ul a t e st ha ts o me on ewh ol a c k sc a p a c i t yc a nb e 26 c a t e g o r i s e da ss ome o n ewh oi su n a bl et oma k ead e c i s i o n i ft h e ya r eu n a bl et ou n d e r s t a n d; 27 r e t a i no rwe i ghu pt hei n f o r ma t i o ni no r d e rt oma kea na u t o no mo u sd e c i s i o n . I nt h i s 28 i n s t a n c e ,i twou l dt h e nb ea r g u e du n d e rt h ed e f e n c ef o rc o n s e nt,n e c e s s i t y ,i l l u s t r a t i n ga

p o s s i bl eo v e r l a p .

I I I . Po t e n t i a lOv e r l a pwi t hDe f e n c eo fNe c e s s i t y I two u l dn o tb eas t r e t c ht os a yt h a ti fs o me o n ewa st ol a c kc a p a c i t y ,t h e ywo ul db eu nl i k e l yt o b ea b l et oc o ns e n tt ot h eme d i c a lt r e a t me n ti nt hefir s tp l a c ea n dt h u swo ul dbea r g ue du n d e r t h ed e f e n c eo fn e c e s s i t y .Th ed e f e n c eo fn e c e s s i t yo ffe r sf o raf a rmor ede fin e dd e f e n c ef o r me di c a lp r of e s s i on a l s ,wi t ht h eMCA a c t i n ga sa u t h or i t yf o rc l i ni c i a n st or e f e rt owhe n o b j e c t i v e l yd e t e r mi n i n gi ft h e i rp a t i e n ti sofs o u ndmi n d . 4 .CONCLUSI ON Th ee xi s t e n c eoft h eTPf o l l o wi n gMo nt g o me r y ,t h o u ghp r o mi n e n t l yp r o b l e ma t i c ,i s 29 u n di s p u t e dt h r o u g ht hes i mp l ef a c tt h a ti ti se mb e d d e dwi t h i nc o mmonl a w. Th i sb e i n gs a i d , u n t i lt h eTEi sa tl e a s tu t i l i s e dwi t h i nl i t i g a t i o n,i ti su n l i k e l yt h a ta n yl i g h twi l lb es h e di n

23 n14 24 n1a t[ 5 0 ]a n d[ 8 7 ]

25 (1985)37SASR524 26 MCA2005s . 2 27 i b i ds . 3 ( 1 ) 28 i b i ds . 4 29 n17 6

r e g a r dst ot h es c o p e ,s t u n t i n gt h ed e f e n c ef r o mb e c o mi n ga c t i o n a b l ewe a k e ne df u r t he rb yt h e c omb i n a t i o no ft h emo r a li mpl i c a t i o n si th a swh e nc o i n c i d i n gwi t hp a t i e n ta u t o n o my . Th eq ue s t i ons t i l lr e ma i nsa st owh e t he rt h ed e f e n c ei sn e c e s s a r ywh e nc o e x i s t i n gwi t ht h e MCA.I ti sd i ffic u l tt ode c i p h e rwh oc o ul dp o s s i b l ys u ffe rad e t r i me ntt ha two u l dn o tb e p r o t e c t e db yt h eMCA,a n di tc o u l db ea r g ue dt h a twi t he x i s t e nc eo fs u c ha c t ,t h e r ei sl i t t l e p u r p o s ef o rt h eTEu n l e s si te x i s t sn a me l ya sas a f e g u a r df o ra na n o ma l ys c e n a r i o .I ti s , t h e r e f o r e ,u pt oi n t e r p r e t a t i o na st owh e t h e ri tc a nb ea‘ t r u ed e f e n c e ’wh e n ,a tt hi smo me n t , t h ed e f e n c ei se n t i r e l yt h e o r e t i c a l .

7...