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Decision Making

Abortion and the cognitively impaired mother

It will be interesting to watch the reception of a recent Court of Protection case, as yet unreported, in which a woman with profound learning difficulties was found to have capacity to decide not to terminate her pregnancy.

As so often, the case decided nothing new. But it is a timely reminder of the trite but often overlooked principle that capacity is not an all or nothing thing. The question: ‘Does she have capacity?’ is always dangerously incomplete. The correct question is always ‘Does she have capacity to decide X?’

There was no doubt that she did not have capacity to manage many aspects of her affairs. She was in the bottom 1% of the population so far as intellectual function was concerned. Deputies were appropriately appointed. But, so far as the continuation of her pregnancy was concerned, so what?

It was decided as a matter of fact that she had capacity to decide whether or not to continue with, or to terminate, the pregnancy. And that meant that the Court of Protection had no jurisdiction to decide the matter. No best interests determination could lawfully be made.Read More »Abortion and the cognitively impaired mother

When to eat the marshmallow: new perspectives on impulse control

In light of the fact that many readers will have an assortment of Christmas treats tempting them, I thought a post on impulse control would be timely.

In the now paradigmatic Stanford marshmallow experiment, children were given an option – one marshmallow which they could have immediately, or two marshmallows, provided they could wait 15 minutes. This option presents a problem of sorts. Is it better to have a small reward immediately, or a larger one after some delay? Common sense says that waiting is the better option. Doubling your reward whilst only paying a marginal cost of your time seems like the rational thing to do. Children who fail to wait are, therefore, seen as succumbing to temptation. A deficiency in self control leads them to make a poor decision.Read More »When to eat the marshmallow: new perspectives on impulse control

Informed consent deserves a little less respect

The conclusions of a ‘citizens’ jury’, reported recently in the British Medical Journal [1] shed light on some important weaknesses in the doctrine of ‘informed consent’. The doctrine is commonly thought of as canonical. Be careful about questioning its exalted status: you’ll be branded paternalistic at best, and the indictment may well involve unflattering comparisons with Dr. Mengele.

The ‘jury’, composed of 25 women,  commented on how a leaflet on breast cancer screening should be re-drafted. The jury preferred:

– the term ‘overtreatment’ to ‘over-diagnosis’

-to express benefits in the language of lives saved rather than deaths avoided

– to talk about ‘benefits’ and ‘risks’ rather than ‘pros’ and ‘cons’

– to begin the leaflet by an up-beat reference to the numbers of lives saved by screening, followed by the caveat that a small number of women would be over-treated.

What was the priority: reassurance or accuracy? The majority (15), wanted both; 3 thought that reassurance was most important; 7 thought that accuracy was the priority.

How should one list the benefits and harms? Four thought they should be listed together in the same sentence, 8 that they should be listed separately, and 12 for mentioning them first separately and then together.

The point of all this  is that there are innumerable different ways, all of which would be smiled on by Bolam [2], in which entirely accurate information can be conveyed. And yet tiny nuances are seen by the receivers of the information as significant.Read More »Informed consent deserves a little less respect

Nine to five philosophers

Owen Barfield was lunching in C.S. Lewis’s rooms. Lewis, who was then a philosophy tutor, referred to  philosophy as ‘a subject’. ‘”It wasn’t a subject to Plato”, said Barfield, “It was a way.”’1 It would be dangerous for a modern professional philosopher to say that her philosophy was her ‘way’. I can well imagine the… Read More »Nine to five philosophers

Watch your words! The challenges of law around the end of life

by Dominic Wilkinson

Here in South Australia last week, a bill has been proposed to clarify the legal status of advance directives. One very small part of that bill involves a modification to an older palliative care act. The modification corrects an ambiguity in wording in the earlier act. The ambiguity is subtle. However, that choice of words has had major consequences for seriously ill children and adults in South Australia and for health practitioners. It is a salutary reminder of how hard it is to enact good laws in the area of end of life, and how easily such laws can make things worse rather than better.

Read More »Watch your words! The challenges of law around the end of life

Want to increase breastfeeding? Then shut up about how it saves money!

by Rebecca Roache

UNICEF today announced research showing that increasing breastfeeding rates in the UK could save the NHS tens of millions of pounds. The report notes that investing more money in encouraging more mothers to breastfeed, and for longer, will pay dividends.

Is this likely to get more mothers breastfeeding? Well, I don’t think we’re off to a very good start. Take a look at some of the headlines used to report this story:Read More »Want to increase breastfeeding? Then shut up about how it saves money!

Should you be prosecuted for feeding junk food to your child?

 By Charles Foster

Fast food permanently reduces children’s IQ, a recent and unsurprising study reports.

What should be done? The answer is ethically and legally simple. Parents who feed their children junk food, knowing of the attendant risks, are child-abusers, and should be prosecuted. If you hit a child, bruising it, you are guilty of a criminal offence. A bruise on a child’s leg is of far less lasting significance than the brain damage produced by requiring a child to ingest toxic junk. A child injured by a negligent or malicious parent can also bring civil proceedings against the parent.

The findings of the recent study mirror those in other jurisdictions. And now that they have been widely disseminated it will be hard for parents to plead ignorance.Read More »Should you be prosecuted for feeding junk food to your child?