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At least 1,621 records · Page 90Linked to original sources
PubMed1991

Can compulsory removal ever be justified for adults who are mentally competent?

Section 47 of the National Assistance Act is controversial in that it makes provision for the compulsory removal and care of mentally competent adults in certain limited circumstances. A case is described in which it is argued that compulsory management could be justified. This is because the diversity and potentially conflicting nature of the relevant considerations involved in this and a restricted range of other cases, defies their being captured in any wholly rational moral scheme. It follows that if the law is to be both sensitive and just it cannot always provide definitive guidance as to how the community doctor, as the designated decision-maker, should act. The acceptance of his or her judgement is therefore necessary and depends for its proper working on trust, which can only be gained through compassion and respect for the patients concerned.

Aged↗
PubMed2002

Comment on Re B (Adult: Refusal of Medical Treatment) [2002] 2 All England Reports 449.

The judgment handed down in the case of Ms B confirms the right of the competent patient to refuse medical treatment even if the result is death. The case does, however, raise some interesting legal points. The facility for conscientious objection by doctors has not previously been explicitly recognised in case law. More importantly perhaps is that the detailed inquiry by the court into Ms B's reasons for refusing treatment, apparently as a precondition for finding her competent, seems to contradict earlier case law where it has been asserted that competent patients can refuse treatment for no reason at all.

Adult↗
PubMed2002

Ms B and Diane Pretty: a commentary.

In two recent court cases, Ms B, a paralysed competent adult, was allowed to end her life; Mrs Pretty, another paralysed competent adult, was not. In legal terms, the essential difference between the two cases is that Ms B was seeking the withdrawal of treatment, whereas Mrs Pretty was asking for assistance in ending her life. I argue that while this distinction may accurately state the law that governs these situations, it does not rest on a defensible moral basis. Both the women should have been allowed to choose the manner in which they would die.

Adult↗
PubMed2002

Grasping the nettle--what to do when patients withdraw their consent for treatment: (a clinical perspective on the case of Ms B).

Withdrawal of active treatment is common in medical practice, especially in critical care medicine. Usually, however, it involves patients who are unable to take part in the decision making process. As the case of Ms B shows, doctors are sometimes reluctant to withdraw active treatment when the patient is awake and requesting such a course of action. In theory, having a competent patient should facilitate clinical decision making, so where does the problem arise? It is argued that latent medical paternalism may come to the surface when doctors are asked by patients to follow a course of action which is in conflict with their own perspective.

Adult↗
PubMed2002

The case of Ms B: suicide's slippery slope?

In the case of Ms B, the High Court ruled that as Ms B was a competent adult patient, her doctors acted unlawfully in overriding her refusal of life-preserving ventilation. This commentary considers whether this case supports the proposition that in English law the right to refuse treatment extends even to refusals which are clearly suicidal.

Adult↗
PubMed2002

A disability perspective from the United States on the case of Ms B.

This article will examine the case of Ms B, a woman with tetraplegia for a year, who, prior to rehabilitation or return to community life, sought a ruling that doctors may turn off her ventilator. The authors are people with disabilities. Their analysis focuses on the manner in which the High Court (a) framed the case in terms of mental capacity, (b) addressed the issue of suicide and ambivalence, and (c) resolved informed consent and treatment alternative issues. While the disability community in the US does not oppose the general right to refuse treatment, there is significant concern about lack of informed consent and denial of desired treatment alternatives, and the cavalier manner in which these factors have been dismissed.

Adult↗
PubMed2002

Consent, sectionalisation and the concept of a medical procedure.

Consent transforms an otherwise illegitimate act into a legitimate one. To be valid, however, it must be adequately informed. The legal requirement is vague and provides little assistance in predicting when it will be satisfied. This is particularly so when a patient consents to a procedure and the physician subsequently varies one of the components of that procedure. Using three legal judgments and one General Medical Council (GMC) decision as a springboard, I have explored the concept of a medical procedure within the context of consent and developed a theoretical model to elucidate a more predictable and consistent informational requirement.

Decision Making↗
PubMed2003

Medical confidentiality and human immunodeficiency virus (HIV) infection: a hypothetical case.

This paper describes a hypothetical case of a HIV positive pilot. It explores legal and ethical aspects of medical confidentiality and discusses who, inside and outside military and medical circles, can be told of his condition in the light of the particular circumstances. Disclosure without the patient's consent is a serious step that should not be undertaken without advice from Service medico-legal departments and medical protection organisations.

Aerospace Medicine↗
PubMed1991

Effects of statutes requiring psychiatrists to report suspected sexual abuse of children.

OBJECTIVE: Reporting of child sexual abuse is mandatory in all 50 states. Conceptual distinctions between privileged communications and mandatory reporting are reviewed, and the impact of recent changes in Maryland's reporting laws is examined. METHOD: Beginning in 1964 Maryland law required reporting if abuse was suspected when a physician examined a child. In 1988 reporting of disclosures by adult patients about child sexual abuse that occurred while they were in treatment was mandated. In 1989 all patient disclosures, even about such abuse that occurred before treatment, became reportable. During the period of statutory changes, the Johns Hopkins Sexual Disorders Clinic had kept track of adult patients who referred themselves for treatment and adult patients' disclosures of child sexual abuse. This allowed analysis of the impact produced by changes in the reporting requirements. RESULTS: 1) Mandatory reporting of disclosures about prior child sexual abuse deterred undetected adult abusers from entering treatment. The rate of self-referrals when such reporting became mandatory in 1989 dropped from approximately seven per year (73 over a 10-year period) to zero. This may have caused some unidentified children to remain at risk. 2) Mandatory reporting deterred patients' disclosures about child sexual abuse that occurred during treatment. In 1988 the disclosure rate during treatment dropped from approximately 21 per year to zero. This deprived clinicians of information important for early intervention. 3) Mandatory reporting failed to increase the number of abused children identified. The number identified secondary to such disclosures was zero. CONCLUSIONS: Optimal protection of children, as well as treatment for adult patients, may be better accomplished by legislation that supports options other than reporting.

Adult↗